Physical therapy (therapeutic exercise)
Facility: William Newton Hospital
Billing Code: 97110 (CPT)
- CPT Billing Code: 97110
- Insurance Median: $58
- Cash Discount Price: $107
- vs. Medicare Baseline: 2.00x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $29.06 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Triwest- All Plans | $37 - $56 | 127% |
| Ambetter / Centene | $38 - $160 | 131% |
| Blue Cross Blue Shield | $38 - $58 | 131% |
| UnitedHealthcare | $38 - $144 | 131% |
| Providrs Care Nexus | $64 - $98 | 220% |
| Providrs Care - All Other Plans | $74 - $112 | 255% |
Consumer Guidance & Cost Commentary
For the CPT code 97110, representing physical therapy services at William Newton Hospital in Winfield, KS, the cash median price is $107.00, which matches the facility's gross charge. This rate is significantly higher than the state average, as indicated by a 200% markup relative to the Medicare benchmark of $29.06. While the facility is a Critical Access Hospital with a government-local ownership structure, patients should be aware that commercial insurance negotiated rates vary widely; for instance, Triwest-All Plans pays a median of $37, while UnitedHealthcare pays up to $144. Because these negotiated amounts often exceed the cash price, paying out-of-pocket can sometimes result in lower total costs for patients with high-deductible plans, provided they secure a prompt-pay discount before the claim is submitted.
To maximize savings, patients should explicitly request a self-pay classification and prompt-pay discount prior to scheduling, as billing systems may automatically submit claims to insurance once a card is on file, voiding any cash agreement. It is also important to avoid balance billing by ensuring all services are covered under the No Surprises Act, particularly since this facility is in-network. If a patient receives an itemized bill, they should review it for errors such as unbundled codes or services not rendered, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute. By comparing the facility's rates directly to the Medicare benchmark and understanding the mechanics of prompt-pay incentives, consumers can make informed decisions that reduce unexpected medical debt.